Healthcare Provider Details

I. General information

NPI: 1659964682
Provider Name (Legal Business Name): AUDREY BLOUNT CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2021
Last Update Date: 02/20/2021
Certification Date: 02/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1065 DELAWARE AVE STE A
MARION OH
43302-6461
US

IV. Provider business mailing address

153 S LEXINGTON SPRINGMILL RD
ONTARIO OH
44906-1327
US

V. Phone/Fax

Practice location:
  • Phone: 740-387-7246
  • Fax:
Mailing address:
  • Phone: 740-358-6551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.021527
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: